Recurrent aphthous ulceration associated with iron deficiency — ORE Part 1 MCQ

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HardOral Medicine and Oral PathologyRecurrent aphthous ulceration associated with iron deficiencyORE Part 1

A 36-year-old woman reports monthly episodes of painful, shallow oral ulcers. They occur on the labial and buccal mucosa and heal completely between episodes. Her haemoglobin is 103 g/L, ferritin is 8 micrograms/L and vitamin B12 is normal. She also reports heavy menstrual bleeding. Which factor most likely contributes to her oral ulceration?

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Correct answer: B — Iron-deficiency anaemia

The correct answer is **B. Iron-deficiency anaemia**. Recurrent aphthous ulcers characteristically affect lining/non-keratinised oral mucosa and recur with complete healing between episodes. This patient has both depleted iron stores (ferritin 8 micrograms/L) and anaemia, plausibly caused by heavy menstrual bleeding. UK oral-medicine guidance advises checking iron, vitamin B12 and folate because deficiency can worsen aphthous ulceration. Recurrent herpes simplex infection usually favours keratinised mucosa, particularly hard palate and attached gingiva. Mechanical trauma typically causes a lesion at a reproducible site adjacent to the source of injury rather than regular multifocal episodes. Squamous cell carcinoma produces a persistent, non-healing ulcer. Pemphigus vulgaris produces fragile bullae and widespread erosions rather than discrete, recurrent aphthae.

Reference: University College London Hospitals NHS Foundation Trust. Recurrent aphthous stomatitis ulcers, section describing site of aphthae and assessment for iron, vitamin B12 and folate deficiency. Current webpage, checked July 2026. https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/aphthous-ulcers